Effect of dexmedetomidine on delirium during sedation in adult patients in intensive care units: A systematic review and meta-analysis

• Published in: Journal of clinical anesthesia 2021-05, Vol.69, p.110157-110157, Article 110157
• Main Authors: Wang, Shuo, Hong, Yishun, Li, Shiyong, Kuriyama, Akira, Zhao, Yilin, Hu, Jinqian, Luo, Ailin, Sun, Rao
• Format: Article
• Language: English
• Subjects: Analgesics; Anesthesia; Bias; Clinical trials; Critical illness; Delirium; Dexmedetomidine; Funding; Intensive care; Meta-analysis; Mortality; Narcotics; Questionnaires; Sleep; Systematic review; Ventilators
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2020.110157

To compare the effect of sedation protocols with and without dexmedetomidine on delirium risk and duration in adult patients in intensive care units (ICUs). A meta-analysis of randomized controlled trials. We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and ISI Web of Science from inception to September 3, 2020. We included studies comparing the effect of dexmedetomidine-based sedation on delirium risk with non-dexmedetomidine-based sedation in adult patients in ICUs. We pooled the data using a random-effects model using Review Manager 5.2, and assessed publication bias using Stata 11.0. The quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation system. We included 36 studies involving 9623 participants. The use of dexmedetomidine was associated with reduced risk of delirium (risk ratio [RR], 0.63; 95% confidence interval [CI], 0.54–0.75; very low-quality evidence), but higher incidences of hypotension and bradycardia during hospital stay. Dexmedetomidine was also associated with shorter durations of ICU stay, hospital stay and mechanical ventilation. Dexmedetomidine did not affect ICU mortality (RR, 1.01; 95% CI, 0.89–1.14; low-quality evidence), hospital mortality (RR, 1.01; 95% CI, 0.91–1.12; very low-quality evidence), or 30-day mortality (RR, 0.77; 95% CI, 0.58–1.01; moderate-quality evidence), or duration of delirium (mean difference, −0.74 days; 95% CI, −1.83 to 0.36 days; very low-quality evidence). We identified publication bias for risk and duration of delirium, length of ICU stay, and hospital stay. Low- or very low-quality evidence suggests that dexmedetomidine was associated with a clinically-small reduction of delirium risk, ICU/hospital stay and mechanical ventilation duration, but were not associated with improved mortality or shorter delirium duration in ICU patients. These findings were inconclusive because of publication bias, heterogeneity, and limited sample size. Significant adverse effects of dexmedetomidine include hypotension and bradycardia. PROSPERO registration number: CRD42018095358. •Dexmedetomidine is associated with a clinically-small reduction of delirium risk.•Dexmedetomidine does not affect short-term mortality in ICU patients.•Dexmedetomidine is associated with shorter mechanical ventilation duration and ICU stay.•Dexmedetomidine is associated with higher incidence of hypotension and bradycardia.